Performing a correct surgical time out

The ending data reflected what we expected in that we would see a significant incline but not quite the 100% compliance rate we are looking for. Our highest compliance rate has reached 90% and we have contributed the margin error to new staff that requires the proper teaching and education. In conclusion I feel that the majority of staff was aware that they were not in compliance with the time out but would proceed anyways due to the rush of the case or surgeon or simply that they had become laxed in practice. Once the data was brought to staff attention and the tracer audits began we saw a quick rise to expectations. Majority of tracer audits were not announced which forced staff to comply with each case. Repetition is seen as a way to increase improvement, my plan for sustainability will have much to do with repetition. The surgical time out is a procedure that is performed with every surgical case so the opportunity to practice / repeat is possible more than one time a day. As staff members in the OR repeat the updated time out the correct way it will reinforce the policy and assist in making it habit. During the Do phase of the SDSA cycle we will be giving and obtaining feedback on what is working well and what is not, any barriers, as well as positive reinforcement. We have discovered that speaking with individuals one on one privately is effective because it holds that individual accountable regarding their faulty performance, but also excludes the embarrassment or anger that would come in a group situation. Positive reinforcement and recognition in the morning huddle however is a nice way to start the day, individuals enjoy being recognized for a job well done. Tracer audits will continue to be performed on a weekly or bi weekly basis and also as surprise audits to assure we are keeping on track. There will continue to be new barriers, suggestions, concerns, etc. that will arise and the only way to continue to improve is to keep a record, the statistical analysis and numbers will show our progress and sustainability or lack of. The work that is being put into this project has become standard, the nurse educator and unit manager have agreed that tracer audits will continue on a regular basis, nurses who find themselves with down time will perform audits on the surgical time out and data will be reported for analysis. The sustainability concept falls in line with the values / mission statement of the hospital to enhance the well-being of people in the communities we serve through a not-for- profit commitment to compassion and excellence in health care services

Overexpression of SepJ alters septal morphology and heterocyst pattern regulated by diffusible signals in Anabaena.

Filamentous, N2 -fixing, heterocyst-forming cyanobacteria grow as chains of cells that are connected by septal junctions. In the model organism Anabaena sp. strain PCC 7120, the septal protein SepJ is required for filament integrity, normal intercellular molecular exchange, heterocyst differentiation, and diazotrophic growth. An Anabaena strain overexpressing SepJ made wider septa between vegetative cells than the wild type, which correlated with a more spread location of SepJ in the septa as observed with a SepJ-GFP fusion, and contained an increased number of nanopores, the septal peptidoglycan perforations that likely accommodate septal junctions. The septa between heterocysts and vegetative cells, which are narrow in wild-type Anabaena, were notably enlarged in the SepJ-overexpressing mutant. Intercellular molecular exchange tested with fluorescent tracers was increased for the SepJ-overexpressing strain specifically in the case of calcein transfer between vegetative cells and heterocysts. These results support an association between calcein transfer, SepJ-related septal junctions, and septal peptidoglycan nanopores. Under nitrogen deprivation, the SepJ-overexpressing strain produced an increased number of contiguous heterocysts but a decreased percentage of total heterocysts. These effects were lost or altered in patS and hetN mutant backgrounds, supporting a role of SepJ in the intercellular transfer of regulatory signals for heterocyst differentiation

Feasibility analysis and performance evaluation and optimization of a DXSAHP water heater based on the thermal capacity of the system: a case study

The present work conducts an evaluation of the feasibility and the overall performance and consequent optimization of a direct expansion solar assisted heat pump (DXSAHP) employed for domestic water heating. For the study conducted R134a, R404A, R407C and R410A working fluids were evaluated as well as the use of four, six and eight flat-plate solar collectors and a worktime ranging from 1 to 6 h. The case study is based in Mexico City with a 300 L container and a hot water outlet temperature of 51 °C. The paper introduces a new evaluation criterion based on the thermal capacity and all the evaluations conducted throughout this research revolve around this performance metric. The results show that, the system would require at least 4 h of operation to achieve the outlet temperature. Additionally, it was found that the R410A refrigerant has the best heat transfer properties; with an average condensation heat rate of 6.31 kW, followed by the R407C with 5.72 kW, the R404A with 5.42 kW and the R134a with 5.18 kW. Diversely, the R134a refrigerant requires 0.402 kW of compression work, 62% less than the R410A, which requires 1.06 kW. Consequently, R134a delivers the highest COP, which ranges from 7 to 14, followed by the R407C and R404A refrigerants, which present a similar behaviour between them, with COP ranging from 5 to 9 and 4 to 8, respectively, and finally the R410A, achieving the lowest COP, ranging from 3.5 to 6.5. Moreover, it was found that the R134a presents a higher dispersion regarding the energy exchange rate, which reveals that it is the fluid most susceptible to external factors, such as the weather. Contrarily, the remaining refrigerants present a more consistent performance. Finally, the optimization revealed that the R407C refrigerant is the most suitable given that it requires 20% less compression work than the R404A. This provides the heat pump system with a steadier behaviour, a COP ranging from 7 to 8, 30% higher than R410A, a worktime decrease of 1.5 h and heat transfer area of 5.5 flat-plate solar collectors, equivalent to a 31% reduction, both compared to R134a.The research work described in this paper was fully supported by the grants from the National Council ofScience and Technology of Mexico and the resources provided by the Applied Thermal and Hydraulic EngineeringLaboratory of the National Polytechnic Institute of Mexico.Peer ReviewedPostprint (published version

Territorios-laboratorio

La crisis de la planificación territorial, cuyo diagnóstico se realiza sintéticamente, reside, aunque sólo parcialmente, en su carencia de estatuto científico. Las disciplinas del territorio deben renovarse a fondo: nada ha ocurrido nunca al margen de la materialidad del territorio. La comunicación presenta un desarrollo parcial del concepto de territorio-laboratorio que se ha elaborado, como operación de desgajar un fragmento del resto del territorio, teniendo en cuenta experiencias investigadoras concretas. Se pretende el análisis del cambio territorial (y urbano) a partir de la delimitación precisa de ciertos fragmentos territoriales, a distintas escalas (micro, intermedias y macro), que sirvan de laboratorio (estable en el tiempo), para definir instrumentos (evaluación de variables, matrices territoriales y de territorialidad, sotfware específico y cartografía) que acerquen con mayor precisión a la comprensión del cambio territorial y sus patrones. Se concretan tales laboratorios en las escalas mencionadas para el caso de Andalucía

Analysis of sexual behaviour in male rabbits across successive tests leading to sexual exhaustion

[EN] Various parameters of sexual behaviour were studied in ten male rabbits daily tested with sexually receptive females (ovariectomized, given estradiol benzoate s.c. 5 µg/day). The aim of this study was to analyse rabbit sexual behaviour during successive tests leading to sexual exhaustion. We allowed copulation ad libitum and determined if sexual satiety was reached within a day and sexual exhaustion across several days. The pair was allowed to copulate freely until the male failed to show sexual interest in that female for 30 minutes. The female was then removed and replaced by another; this procedure was repeated using as many does as needed, until the male showed no interest in any female for 2 hours. Scent-marking (chinning) was also recorded, before and after the copulation test. This whole procedure was repeated daily until the male showed no sexual behaviour at all on a given day. Within a test, copulation ad libitum led to a gradual increase in the time interval between successive mounts and ejaculations, regardless of the day of testing. Such increments predicted that the buck was reaching sexual satiety. The "miss" rate (i.e., the proportion of mounts that did not culminate in ejaculation) significantly increased from a median of 25 on the first day to 55 on the last day of testing. The mean time to reach copulatory inactivity decreased from 4 hrs on the first day to 1 hr on the last day. The total number of ejaculations within a test decreased from an average of 22 to 6 (first vs last day, respectively) and the number of chin marks was reduced by 69% compared with pre-mating values, regardless of the day of testing. All bucks eventually stopped copulating after a variable number of days (range=2-15 days). We concluded that, following copulation ad libitum with several females, male rabbits reach sexual satiety (i.e., they are unable to continue copulating on the same day) and, after several days, they also attain sexual exhaustion, a state in which copulation is totally arrested for at least 24 hours. Some behavioural parameters can be used as reliable predictors that a buck is approaching sexual satiety and sexual exhaustion.Jimenez, P.; Serrano-Meneses, M.; Cuamatzi, E.; González-Mariscal, G.; González-Maris (2012). Analysis of sexual behaviour in male rabbits across successive tests leading to sexual exhaustion. World Rabbit Science. 20(1):13-23. doi:10.4995/wrs.2012.1034SWORD132320

Music distraction among young drivers: analysis by gender and experience

The aim of this study was to quantify the probability of committing a speed infraction by young drivers and to investigate to what extent listening music could affect young drivers’ emotions as well as their driving performances at the wheel. To achieve this aim, employing Bayesian networks, the study analysed different music styles, in which they resulted in sample drivers’ speed infractions. Gender and drivers’ experiences at the wheel were the other factors, which were taken into account when interpreting the study results. Variables taken into account in this study included type of music whilst driving, gender of drivers, and drivers’ driving experiences. These variables further incorporated into the study of other telemetric variables including acceleration, number of revolutions per minute (RPM) of the engine, brake, traffic, and other types of infractions other than speed, which were considered as dependent variables. A driving simulator was used, and different driving simulation studies were carried out with young people aged between 20 and 28 years. Each participant carried out three simulations by listening to different type of music in each journey. The study defined a conceptual model in which the data were analysed and evaluated mathematically through Bayesian networks. A sensitivity analysis was performed to evaluate the influence of music on driving speed. Based on the different variables, the study further analysed the probability of speed infractions committed by drivers and their adequate speed. The range of frequency probabilities varied between 96.32% (which corresponds to experienced male drivers who do not listen to music) and 79.38% (which corresponds to less-experienced female drivers who listen to music), which resulted in their happiness or aggression.FEDER (Fondo Europeo de Desarrollo Regional) for developing Castilla y Le´on´s region. *e title of the project is “Modelizaci´on mediante t´ecnicas de machine learning de la influencia de las distracciones del conductor en la seguridad vial-Modeling the influence of driver´s distractions on road safety through machine learning techniques.” Ref. BU300P1

Clavo gamma: indicaciones, resultados y complicaciones

El clavo gamma ha sido utilizado como osteosíntesis en el tratamiento de 50 fracturas proximales de fémur, 28 de las cuales fueron consideradas inestables (56%). En cuanto a la consolidación sólo hubo un fracaso con rotura del implante (2%); el resto de los pacientes evolucionaron hacia la curación, precisando 2 de ellos una segunda intervención para dinamizar el foco de fractura mediante la retirada de los tornillos de bloqueo distales. Estos buenos resultados contrastan con las complicaciones surgidas durante la intervención y el postoperatorio inmediato: fisura diafisaria intraoperatoria (8%), fractura diafisaria intraoperatoria (4%), problemas en la colocación de los tornillos de bloqueo distales (6%) y fracturas diafisarias postoperatorias por debajo del clavo (4%). El clavo gamma tiene su indicación en las fracturas proximales inestables de fémur siempre que se realice una técnica quirúrgica rigurosa que minimice los riesgos de complicaciones.The gamma nail has been used as osteosynthesis for the treatment of 50 proximal fractures of femur, 28 of which (56%) were considered unstable. Regarding to consolidation, there was one only failure with breaking of the implant (2%). The remaining patients achieved healing, two of them requiring a second intervention in order to activate the fracture focus through withdrawal of the distal blocking screws. These good results contrast with the complications that appeared during intervention and inmediate postoperatory period: intraoperatory diaphyseal fissure (8%), intraoperatory diaphyseal fracture (4%), problems with setting of distal blocking screws (6%) and postoperatory diaphyseal fractures below the nail (4%). The gamma nail has its indication for proximal unstable fractures of femur, as long as a rigorous surgical technique is practiced, thus minimizing the risks of complications

The Fougueux (1785-1805): prototype of an 18th–19th century French construction method

The 74-gun French ship Fougueux (1785-1805) belonged to the Spanish-French fleet that faced the British in the Battle of Trafalgar on 21 October 1805. This warship was lost off the coast of Sancti Petri after the battle. About two centuries later, an array of iron cannons and wooden remains were studied at this site by the Underwater Archaeology Centre of Andalusia. This paper presents the results of the analysis of the ship’s construction method, whose particularities place it within the tradition of French naval construction between the late 18th century and early 19th century.Le navire français de 74 canons Le Fougueux (1785-1805) appartenait à la flotte franco-espagnole qui affronta les Britanniques lors de la bataille de Trafalgar le 21 octobre 1805. Ce navire de guerre fut perdu au large de Sancti Petri après la bataille. Environ deux siècles plus tard, un ensemble de canons de fer et de vestiges en bois ont été étudiés sur ce site par le Centre d’archéologie sousmarine d’Andalousie. Cet article présente les résultats de l’analyse des méthodes de construction du navire, que ses particularités placent dans la tradition de la construction navale française entre la fin du xviiie et le début du xixe siècle.Fil: Rodríguez Mariscal, Nuria E.. Centro de Arqueología Subacuática de Andalucía; EspañaFil: Ciarlo, Nicolás Carlos. Universidad de Buenos Aires. Facultad de Filosofía y Letras. Instituto de Arqueología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Alzaga García, Milagros. Centro de Arqueología Subacuática de Andalucía; EspañaFil: Rieth, Eric. Servicio de Patrimonio Histórico-artístico y Museo; EspañaFil: Izaguirre Lacoste, Manuel. Universite de Paris. Museum National D´historie Naturelle. Centre National de la Recherche Scientifique; Franci

General quasi-non-spreading linear three-dimensional wave-packets

We introduce a general approach for generation of sets of three-dimensional quasi-non-spreading wavepackets propagating in linear media, also referred to as linear light bullets. The spectrum of rigorously non-spreading wavepackets in media with anomalous group velocity dispersion is localized on the surface of a sphere, thus drastically restricting the possible wavepacket shapes. However, broadening slightly the spectrum affords the generation of a large variety of quasi-non-spreading distributions featuring complex topologies and shapes in space and time that are of interest in different areas, such as biophysics or nanosurgery. Here we discuss the method and show several illustrative examples of its potential.Comment: 3 pages, 4 figures, to appear in Optics Letter

Changing Dose of Progesterone Results in Sudden Changes in Frequency of Luteinizing Hormone Pulses and Secretion of 17β-Estradiol in Bovine Females

The aim of the present study was to elucidate the time course according to which changes in circulating concentrations of progesterone influence pulsatile secretion of LH and secretion of 17β-estradiol. Our working hypothesis was that changing the dose of progesterone would result in changes in frequency of LH pulses and secretion of 17β-estradiol within 72 h. Five days after behavioral estrus, thirty-three cows were randomly assigned to one of five groups: 1) control, no treatment (CONT, n = 5); 2) treatment with two progesterone-releasing intravaginal devices (PRIDs) for 11 days (2PRID, 5-6 ng/ml plasma progesterone, n = 7); 3) treatment with a 0.5 PRID for 11 days (0.5PRID, 1-2 ng/ml plasma progesterone, n = 7); 4) treatment with 2 PRIDs for 8 days followed by treatment with a 0.5 PRID for 3 days (2-0.5PRID, n = 7); and 5) treatment with a 0.5 PRID for 8 days followed by treatment with 2 PRIDs for 3 days (0.5-2PRID, n = 7). Cows subject to PRID treatments received injections of prostaglandin F2 on Days 1 and 2 (Day 0 = day of initiation of PRID treatments, fifth day of the estrous cycle in CONT cows) to lyse the existing corpus luteum. Cows were bled for 12 h at 15-min intervals on Day 7.5 of the treatment period (twelfth day of the estrous cycle in CONT cows). The dose of progesterone was changed on Day 8 in cows that were assigned to the 2-0.5PRID and 0.5-2PRID groups, and blood collections continued an additional 72 h to characterize profiles of circulating concentrations of LH and 17β-estradiol. Cows treated with a 0.5 PRID had a greater (p \u3c 0.05) number of LH pulses and higher (p \u3c 0.05) concentrations of 17β-estradiol throughout the entire blood collection period than cows in the 2PRID and CONT groups. An increase in the number of LH pulses was detected within 6 h after the change from the high to the low dose of progesterone (2-0.5PRID), and frequency of LH pulses was similar to that of cows in the 0.5PRID group for the remainder of the period of blood collection. LH pulse frequency declined within 6 h after the shift from the low to the high dose of progesterone (0.5-2PRID) and was similar to that of cows in the 2PRID group by 12 h after the dose was changed. Within 6 h after the dose of progesterone was changed, circulating concentrations of 17p-estradiol increased (p \u3c 0.05) in cows shifted from the high to low dose (2-0.5PRID) and declined (p \u3c 0.05) after the dose of progesterone was changed from low to high (0.5-2PRID). We conclude that changing the circulating concentrations of progesterone concurrently affects frequency of pulsatile LH release and secretion of 17β-estradiol within 6-24 h